HDSA Annual Convention Scholarship 2018 Made possible by Lundbeck

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1 HDSA Annual Convention Scholarship 2018 Made possible by Lundbeck The is pleased to announce it is now accepting applications for scholarships to attend the 33 rd Annual HDSA Convention in Los Angeles, CA this June. This scholarship program is made possible by the generous support of Lundbeck. The intent of this scholarship program is to help families and individuals who have never been to an HDSA Convention attend the Society s 2018 Annual Convention. Scholarship Availability & Application The scholarship is open only to first time Convention attendees who are not California residents. (California residents please see separate scholarship applications.) Applicants must be 18 years or older as of January 1, Open to residents of the United States only. The 2018 Convention Scholarship Application follows this introduction. The application is also available online from the HDSA website ( What does the Scholarship cover? Travel by Plane - Scholarship will cover: Round-trip airfare up to $500 per person for up to four family members (please note you must book and pay for your airfare and you will be reimbursed at the Convention); One hotel room for up to four family members at the Los Angeles Airport Marriott for 3 nights, June 7 - June 9; Convention Registration Fees for up to four family members; and Saturday night Convention Gala tickets for up to four family members. Travel by Automobile - Scholarship will cover: Roundtrip mileage reimbursement at 54.5 cents per mile up to 1,000 miles round trip (distance to be calculated on Google Maps); One hotel room for up to four family members at the Los Angeles Airport Marriott for 3 nights, June 7 - June 9; Convention Registration Fees for up to four family members; and Saturday night Convention Gala tickets for up to four family members.

2 2 What doesn t the Scholarship cover? - Hotel incidentals (You will need to have a credit card and ID to check into your room.) - Transportation to and from the hotel/airport. - Meals that are not provided as part of the Convention registration. (Registration includes Friday lunch, Saturday breakfast and Saturday dinner.) Application Deadline: Applications must be received no later than midnight, Wednesday, April 4, The application and all required signatures are to be mailed to: Convention Scholarship Attention: Robert Coffey Applications may also be submitted via fax to or a scanned pdf may be ed to Notification of Winners Applicants will be notified no later than May 1, 2018 as to whether they have been awarded a scholarship. Attached: HDSA Annual Convention Scholarship

3 3 HDSA Annual Convention Scholarship Application This, and all following pages, must be completed in full and submitted to HDSA as your application for the HDSA Annual Convention Scholarship. All information contained on this application will be kept in strict confidence. Deadline: Wednesday, April 4, 2018 Determination of Scholarship Awards You will be notified no later than May 1, 2018 as to the status of your Convention scholarship application. Applicant (all fields are required, no P.O. boxes please) Lead Applicant

4 4 Sections 1 through 7: HDSA Annual Convention Scholarship 1. I and my family members listed on this application have never attended an HDSA Annual Convention before. (To receive a scholarship, you and the family members listed on this application must not have attended a previous HDSA Annual Convention.) 2. Did you apply for a Convention scholarship in a previous year? Yes No If yes, what year? 3. Are you actively part of a local HDSA Chapter/Affiliate and/or support group? Yes No If yes, please provide the name of the Chapter/Affiliate and/or support group location. 4. Travel a. Will you require airfare to Convention: Yes No b. If yes, what is your originating airport: c. No, I will be driving to the Convention approximately miles roundtrip. 5. The total 2017 Gross Annual Income for your household was: Under $20,000 $20,000 but under $45,000 $45,000 but under $70,000 $70,000 or higher 6. Why do you wish to attend the HDSA Annual Convention and how would a scholarship be beneficial to you and your family? (Please use additional paper if you need more space.)

5 5 7. Release of Liability I hereby accept full responsibility for the safety and care of myself and the family members travelling with me should I be awarded an HDSA Annual Convention Scholarship. I and my family members traveling with me are able to travel on our own and attend the HDSA Annual Convention in Los Angeles, CA without aid or supervision. Signature of Applicant: Date: Print Deadline & Mailing Instructions This application, including essay, all attachments and required signatures, must be received no later than midnight, Wednesday, April 4, Applications are to be mailed to: Convention Scholarship Attention: Robert Coffey Applications may also be submitted via fax to or a scanned pdf may be ed to Application Check list: Did you remember to [_] Fill out all fields in the application [_] Sign all the forms # # # Thank you! Someone will contact you by May 1, 2018 to let you know if you have received scholarship support.

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